What Would You Do? — PEAK Agent Training

Six real situations. Think through what you'd actually say before revealing the reasoning.

Scenario 1

A client sees two specialists every month. Their current plan has a $55 specialist copay; the plan you're comparing has a $25 specialist copay.

What to do

Translate the copay difference into their actual usage: $55 × 2 visits = $110/month vs. $25 × 2 visits = $50/month — a $60/month difference for visits they're already making. Then ask whether lowering that cost would help them, and let them decide.

Scenario 2

A client says: "I don't want to change. I already have dental." Their current plan has a $1,500 dental allowance; the plan you're comparing offers $3,000.

What to do

Don't just repeat the bigger number back to them. Ask about their actual dental needs — upcoming work, ongoing treatment, past experience with dental costs. If there's a real scenario where the difference would matter, paint that picture. If not, having dental already may genuinely be enough for them.

Scenario 3

A client has always used a PPO, but MARx shows they're scheduled to move to an HMO next month.

What to do

Investigate why the change occurred and whether the client actually understands it. Find out who their doctors are, how much they personally value network flexibility, and confirm the specific HMO's actual rules before assuming this change is good, bad, or something the client even chose intentionally.

Scenario 4

A client only wants the food benefit they saw advertised, but they don't appear to be eligible for it based on what you can verify.

What to do

Don't automatically end the call. Determine the underlying need behind wanting that benefit — usually cash flow — and look into other legitimate savings or assistance options without promising eligibility for anything you haven't confirmed.

Scenario 5

The plan you're comparing looks excellent on the medical side, but an important prescription shows "Not Covered."

What to do

Slow down. Verify the medication, brand vs. generic, and the formulary before drawing any conclusion. Check for a covered alternative and any restrictions. If appropriate, explain that a coverage determination or formulary exception is a process the beneficiary or prescriber can request — never promise it will be approved.

Scenario 6

You genuinely cannot find an alternative plan that improves this client's situation.

What to do

Tell them the truth. Don't manufacture a reason to switch just to close something. If there's a legitimate follow-up reason — a pending eligibility change, for example — document it and set an appropriate follow-up. “Your current plan appears to fit your needs better” is a complete, honest outcome.